Tuesday, December 10, 2013

Obamacare and AIDS

One would assume that if anybody should benefit from Obama's changes to the healthcare laws, it would be people with AIDS. HIV positive people have been lobbying for government assistance since the nature of the disease first became evident in the 1980s, and Democratic politicians have led the charge to find a cure--or at least a treatment--for a disease that now affects millions of people, heterosexual and homosexual alike, around the world.

But people who expected the new plans to provide pharmaceutical coverage
comparable with that of employer-sponsored plans have been
disappointed. In recent years, employers have compelled workers to pick
up a growing share of the costs, especially for brand-name drugs. But
insurers selling policies on the exchanges have pared their drug
benefits significantly more, according to health advocates, patients and
industry analysts. The plans are curbing their lists of covered drugs
and limiting quantities, requiring prior authorizations and insisting on
“fail first” or “step therapy” protocols that compel doctors to
prescribe a certain drug first before moving on to another — even if
it’s not the physician’s and patient’s drug of choice.

The disruption to the existing market leaves many AIDS patients who were covered worse off than they were before:

Paul Prince, 52, a former information technology manager from
Houston, said he was surprised that some of the health plans in the new
federal marketplace wouldn’t pay for one or more of his HIV medications.
The policy that seemed to provide the best coverage, he said, would
cover only about two-thirds of his monthly $2,400 drug tab, leaving him
responsible for $840.

“There was no way I could pay that,” said Prince, who is
studying to become a teacher after being laid off from his previous job
and losing his insurance.

Insurers have responded Obamacare's prohibition against discrimination on the basis of pre-existing conditions by cutting costly benefits--like expensive drugs. The Post cites a study by Avalere Health:

A new analysis of health plans sold in the federal exchange —
which covers 36 states — and 14 state exchanges found that the benefits
tend to be skimpier than in most other private insurance in the United
States, with drug benefits a particular weak spot.

Right now, this only affects the 5% of Americans who get their insurance on the individual market, but the Post reports that many employers are already thinking about cutting costs the same way.

Dan Mendelson, Avalere’s chief executive, predicted that employers may
soon adapt some of the benefit designs in the exchanges’ health plans.
“We are already seeing interest,” he said, because they are less
expensive for companies, shifting more of the expense to patients.

The Washington Post article makes it clear that (a) this problem affects a larger group of illnesses, including cancer, multiple sclerosis, rheumatoid arthritis and autoimmune disease and (b) AIDS activists are working hard to change the rules to solve the problem--for people with HIV.

If you care about someone with AIDS, read the Washington Post article and pass it on.

If you care about someone with cancer, multiple sclerosis, rheumatoid arthritis, autoimmune disease, or another disease that involves expensive medications, you may want to subscribe to this blog.